Medicare Advantage premiums vary widely, but most people pay between $0 and $200 per month in addition to your Part B premium

A Medicare Advantage plan (also called Part C) replaces Original Medicare and is offered by private insurance companies. The plan itself has its own premium — what you pay monthly to the insurer — separate from the Part B premium you send to Medicare. Some plans charge $0 per month; others charge $150 or more. The amount depends on which plan you pick, which insurance company offers it, and where you live.

You always pay your Part B premium to Medicare no matter which plan you choose. On top of that, you pay the Advantage plan's premium directly to the insurance company. If you get Part D prescription drug coverage through your Advantage plan (most do), that cost is bundled into the plan premium rather than charged separately.

The actual dollar amount changes every year. Medicare sets the rates each fall, and plans announce their 2025 premiums in October. If you are already enrolled, your plan will mail you a notice showing what you will pay starting January 1.

Key Takeaways

  • Medicare Advantage premiums range from $0 to over $200 per month depending on the plan and your location, and you pay this on top of your Part B premium.
  • Most plans include prescription drug coverage (Part D) in their premium, so you do not pay a separate drug plan fee.
  • You may also pay copays when you see a doctor, visit an urgent care center, or fill a prescription — these are separate from the monthly premium.
  • Plans with $0 premiums exist in most areas but often have higher copays and smaller provider networks than plans that charge more upfront.
  • Premiums change every January, and you can switch plans during the annual open enrollment period (October 15 to December 7) if your costs rise.

How premiums are set and what they cover

Each insurance company decides what to charge for its Medicare Advantage plans in your county. Medicare does not set the premium amount — it only approves or rejects the plan. This means two plans in the same town, offered by different companies, can have very different premiums.

The premium you pay covers the plan's basic structure: access to the insurer's doctor network, hospital coverage, and usually prescription drug coverage. It does not cover the copays you pay when you actually use care. A plan with a $0 premium might charge you $40 to see a primary care doctor and $200 for an emergency room visit. A plan with a $150 monthly premium might charge $15 to see a doctor and $100 for the emergency room.

Insurance companies use premiums to compete for members. A company might offer a $0 premium plan to attract people who are price-sensitive upfront, knowing they will make money from copays and deductibles when those members use services.

Out-of-pocket costs beyond the monthly premium

The monthly premium is only part of what you pay. When you use your plan, you also pay:

  • Copays: A fixed dollar amount for a specific service — for example, $25 to see a specialist or $10 for a generic prescription.
  • Coinsurance: A percentage of the cost after you meet your deductible — for example, you pay 20% of the cost of an outpatient surgery and the plan pays 80%.
  • Deductibles: The amount you must pay out of your own pocket before the plan starts to pay. Some plans have no deductible; others have deductibles of $500 or more.
  • Out-of-pocket maximum: The most you will pay in a calendar year for copays, coinsurance, and deductibles combined. Once you reach this limit, the plan pays 100% of covered services for the rest of the year. Most plans cap this between $6,700 and $7,550 for 2024, though the exact amount varies by plan.

These costs are separate from your premium. A plan with a low premium often has higher copays and a higher out-of-pocket maximum. A plan with a higher premium often has lower copays and a lower out-of-pocket maximum. The trade-off is real: you choose whether to pay more upfront or more when you use care.

Costs for specific services and situations

Medicare Advantage plans must cover the same basic services as Original Medicare: hospital stays, doctor visits, preventive care, and emergency services. However, the copays and coinsurance vary by plan and by service type.

A typical plan might charge $0 for preventive services like annual checkups and screenings, $25 to $50 for a primary care visit, $40 to $75 for a specialist visit, and $250 to $500 for an emergency room visit (though this copay is waived if you are admitted to the hospital). Prescription drugs have their own cost structure: plans use a formulary (a list of covered drugs) and charge different copays based on the drug tier — generic drugs cost less than brand-name drugs.

If you need ongoing care — for example, physical therapy after surgery or dialysis for kidney disease — the plan will have a copay for each session. Some plans limit the number of sessions covered per year; others do not. This is a detail worth checking if you know you will need that service.

How to compare costs across different plans

The easiest way to see actual costs is to use the Medicare Plan Finder tool on Medicare.gov. You enter your zip code, the medications you take, and the doctors you see. The tool shows you every plan available in your area, lists the monthly premium, and estimates your total out-of-pocket cost based on your specific situation.

When you compare plans, look at three numbers: the monthly premium, the out-of-pocket maximum, and the estimated annual cost (which the Plan Finder calculates for you). The estimated annual cost includes the premium plus the copays and coinsurance the tool predicts based on your health history and medications. This number is more useful than the premium alone because it shows the real total you are likely to pay.

Also check whether your doctors and hospitals are in the plan's network. A plan with a low premium is not a bargain if your cardiologist is not in the network and you have to pay out-of-network rates (which are much higher) or switch doctors.

Extra costs: dental, vision, and hearing

Original Medicare does not cover dental, vision, or hearing services. Many Medicare Advantage plans do offer these benefits, but they are usually limited. A plan might cover a dental cleaning twice a year and basic fillings, but not crowns or implants. Vision coverage often means one eye exam per year and a small allowance toward glasses or contacts.

These benefits are included in the plan premium — you do not pay extra for them. However, the coverage is capped. If you need extensive dental work or hearing aids, the plan's benefit will cover only part of the cost, and you will pay the rest out of pocket. Read the plan's summary of benefits to see exactly what is covered and what the limits are.

When and how premiums change

Medicare Advantage premiums can change every January 1. In the fall (usually October), Medicare announces the rates for the coming year, and each insurance company decides whether to raise, lower, or keep its premiums the same. Plans can also change their copays, deductibles, and out-of-pocket maximums at the same time.

If your plan's costs go up, you have options. During the annual open enrollment period (October 15 to December 7), you can switch to a different Medicare Advantage plan, switch to Original Medicare, or add or drop Part D prescription drug coverage. You do not need a reason to switch — open enrollment is your window to change plans without penalty.

If you miss open enrollment, you are locked into your plan for the rest of the year unless you have a may have access to life event (such as moving to a new state, losing employer coverage, or becoming may be able to access for Medicaid). Plan changes made outside open enrollment take effect the first of the month after you make the change.

Income-based help paying premiums and copays

If your income is low, you may be able to get help paying your Medicare premiums and copays through a program called Extra Help (for prescription drugs) or Medicare Savings Programs (for premiums and copays). These programs are run by your state, not by Medicare directly.

To find out whether you may have access to, contact your state Medicaid office or call 1-800-MEDICARE. You will need to provide proof of income and citizenship. If you may have access to, the program pays some or all of your Part B premium, and in some cases your plan premium as well. Copays may be reduced to $1 to $3 per service.

These programs have income limits that vary by state. In most states, you may have access to if your income is below 150% to 200% of the federal poverty level, but some states are more generous. It is worth checking even if you think you earn too much, because the rules are different in each state.

Frequently Asked Questions

Can I get a Medicare Advantage plan with no premium at all?

Yes. Many insurance companies offer $0 premium plans in most areas. However, these plans typically have higher copays and smaller provider networks than plans that charge a monthly premium. You still pay your Part B premium to Medicare; the $0 refers only to the plan's own premium.

What is the difference between a copay and coinsurance?

A copay is a fixed dollar amount you pay for a service — for example, $25 to see a doctor. Coinsurance is a percentage of the cost — for example, you pay 20% of the cost of an outpatient surgery and the plan pays 80%. Plans use both, depending on the service.

If I switch Medicare Advantage plans, do I have to pay a penalty?

No. You can switch plans during open enrollment (October 15 to December 7) without any penalty. If you switch outside open enrollment, you need a may have access to life event such as moving or losing employer coverage. There is no financial penalty for switching; you straightforward cannot do it whenever you want.

Are prescription drugs more expensive on Medicare Advantage than on Original Medicare with a separate Part D plan?

It depends on the specific plan and the drugs you take. Some Medicare Advantage plans have lower drug copays than standalone Part D plans; others have higher copays. Use the Medicare Plan Finder to compare the actual cost of your medications under different plans in your area.

What happens if I reach my out-of-pocket maximum partway through the year?

Once you reach your plan's out-of-pocket maximum, the plan pays 100% of your covered services for the rest of the calendar year. You pay nothing more for copays, coinsurance, or deductibles. The out-of-pocket maximum resets on January 1 of the next year.